Fillable City of Bixby SPECIAL EVENT PERMIT APPLICATION (City of Bixby)

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City of Bixby SPECIAL EVENT PERMIT APPLICATION (City of Bixby)

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City of Bixby
FOR INTERNAL USE ONLY
Application Rec’d
Approved
Refundable
Deposit Due
Event Fee Due
Date Paid
SPECIAL EVENT PERMIT APPLICATION
All events occurring within the City of Bixby, no matter how large or small, must complete a Special Event
Permit Application and receive approval from the City of Bixby Special Events Team before obtaining a
permit. Event Organizers are required to submit the Special Event Permit Application form a minimum of 45
days prior to the event. Please note late submissions may result in an automatic denial. Applications may be
approved, asked to make changes, or denied based on availability of facilities, services, dates, and/or logistics.
Any event taking place in the park without the authorization of the team will be asked to leave.
Prior to completing this application please read the Specials Events Guide and direct any questions to Jennifer
Rush, Public Information/Events Coordinator, jrush@bixbyok.gov
or 918-366-0417.
Organization Name *______________________________________________________________________
Name of the Event *_______________________________________________________________________
Date(s) of Proposed Event *_________________________________________________________________
Time(s) of Proposed Event *________________________________________________________________
Type of Event*
☐Festival ☐ Concert ☐Food ☐Block Party ☐Fishing ☐Parade
☐Fundraiser ☐ Community ☐Private ☐Business ☐Sports (5K, Cycling, Basketball, etc)
☐Other __________________________________________________________________________________
Event General Location*
☐Washington Irving Park ☐Charley Young Event Park ☐Quail Creek Park
☐Bentley Park ☐Bixhoma ☐Neighborhood (Please list name)__________________________
☐Other (Please list address or location) _________________________________________________
Event Description *
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Expected Attendance * Is this a new event? * Is the General Public invited? *
___________________ ☐Yes ☐No ☐Yes ☐No
Is there an admission fee to participate?* ☐Yes ☐No Amount? ____________________
Is there an admission fee to spectate?* ☐Yes ☐No ☐N/A Amount? ____________________
2
ORGANIZATION & CONTACT INFORMATION
Event Organizer Contact Name * ____________________________________________________________
Cell Phone* ____________________ Alternate Phone* ____________________
Email* _______________________________________________________________
Secondary Organizer Contact Name * ________________________________________________________
Cell Phone* ____________________ Alternate Phone* ____________________
Email* _______________________________________________________________
Organization Full Address* ________________________________________________________________
Event Social Media Pages* _________________________________________________________________
Organization Website* ____________________________________________________________________
Event Website* __________________________________________________________________________
ADDITIONAL EVENT INFORMATION
Please list 2 to 3 sentences that describe the event to the General Public: *
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Phone number for the General Public to inquire about the event: * _______________________________
Email or social media for the General Public about the event: *
_________________________________________________________________________________________
_________________________________________________________________________________________
Event set-up date(s) and time(s) requested * ___________________________________________________
Is the event a series? ☐ Yes ☐ No If yes, how frequently the event will occur? *
_________________________________________________________________________________________
Does the event benefit another organization? * ☐ Yes ☐ No
If yes, please list: _________________________________________________________________________
Has the City of Bixby been added as a certificate holder to a Liability Insurance policy with an
aggregate limit of liability of not less than one million dollars ($1,000,0000) ? * ☐ Yes ☐ No
Will signage be used*? ☐ Yes ☐ No If yes, please describe: ____________________________________
_________________________________________________________________________________________
Will there be live entertainment? * ☐ Yes ☐ No
Will a public announcement system be utilized? * ☐ Yes ☐ No
Will an event stage be utilized? * ☐ Yes ☐ No
Have adjacent property/business owners been notified? * ☐ Yes ☐ No
3
Will there be product sales (other than food or beverage) at the event? * ☐ Yes ☐ No
PARKS INFORMATION
Will the event or vendors need access to electric? * ☐ Yes ☐ No
Will the event or vendors need access to water? * ☐ Yes ☐ No
Will the event need access to restroom facilities? *☐ Yes ☐ No
If over 300 in attendance are expected, have you made arrangements for Porta Jon delivery? *
☐ Yes ☐ No Delivery date: __________________________ Pickup date: __________________________
Will the event utilize tents? * ☐ Yes ☐ No
Have arrangements been made with a refuse service? * ☐ Yes ☐ No
Will carnival or other type rides be included in the event? * ☐ Yes ☐ No
If utilizing a City Park, please indicate the proposed location(s) to be utilized for the event *
Washington Irving Park
Bentley Park
Charley Young Park
Bixhoma Lake
☐
Section 1
☐Section 2
☐Section 3
☐Section 4
☐Section 5
☐Section 6
☐
Baseball Quad
☐Softball Quad
☐Soccer Complex
☐ Basketball Courts
☐Splash Pad
☐Playground
☐Lawn
☐Stage
☐Concessions
☐
Splash Pad
☐Playground
☐Lawn
☐Stage
☐Food Truck Areas
☐
Launch Dock
☐Fishing Dock
☐Launch Dock
☐ Recreation Area
☐ Picnic Area
☐ Camping Area
☐ Hiking Trail
☐ Gazebo
TRAFFIC & PUBLIC SAFETY
Will the event need street closures? * ☐ Yes ☐ No
If yes, please list anticipated street closures: * _____________________________________________
__________________________________________________________________________________
Are barricades needed? * ☐ Yes ☐ No
If yes, please list requested barricade locations: * __________________________________________
__________________________________________________________________________________
Does the event have a plan for parking? * ☐ Yes ☐ No
If yes, please list parking information including location: * __________________________________
__________________________________________________________________________________
Will volunteers be utilized to assist with parking? * ☐ Yes ☐ No
Will the event utilize a shuttle service? * ☐ Yes ☐ No
4
TRAFFIC & PUBLIC SAFETY CONTINUED
Will the event require security or traffic assistance from the Bixby Police Department? * ☐ Yes ☐ No
If yes, have you contacted the police department to obtain approval to hire off-duty officers?
* ☐ Yes ☐ No
If no, has the event made arrangements for security from another provider? * ☐ Yes ☐ No
Is the use of a helicopter being planned? * ☐ Yes ☐ No
Will fireworks or other pyrotechnics be used during the event? * ☐ Yes ☐ No
Will the event provide on-site medical or first aid care? * ☐ Yes ☐ No
Will the event involve any type of firearm or replica firearm? * ☐ Yes ☐ No
Will any Hazardous Materials be present at the event? * ☐ Yes ☐ No
If the event is a run, ride, or parade will there be a marked lead vehicle and/or rear vehicle? * ☐ Yes
☐ No ☐ N/A
FOOD & BEVERAGE
Will food be provided at the event? * ☐ Yes ☐ No
If yes, who will be providing food at the event?
☐Food Trucks ☐Sponsoring Organization ☐Tented Vendors
☐Other ______________________________________________
Do vendors all have proper Oklahoma State Department of Health Food Permits?
* ☐ Yes ☐ No
Do vendors all have a City of Bixby Food Permit issued by the Tulsa County Health Department?
* ☐ Yes ☐ No
Will vendors be notified that they must receive an itinerant vendor license with the City of Bixby within
15 days of the event? (This excludes Tier 1 events.)
* ☐ Yes ☐ No
Will food vendors need access to food truck parking at the Park?
* ☐ Yes ☐ No
Will alcoholic beverages be served/sold at the event? * ☐ Yes ☐ No
If yes, who will be providing alcoholic beverages at the event?
☐Food Trucks ☐Sponsoring Organization ☐Tented Vendors
☐Other _______________________________________________
If alcohol will be sold or served, has proper permitting through ABLE commission been obtained?
☐ Yes ☐ No
5
PLEASE INCLUDE THE FOLLOWING ATTACHMENTS IF APPLICABLE:
☐
Event Site Plan*
☐
Route Maps for Runs, Rides, and/or Parades
☐
Event Public Safety & Parking Plan
☐
Certificate of Insurance*
☐
IRS Not-for-Profit Determination Letter
☐
Press Releases
☐
Event Flyers, Brochures, and/or Social Media Graphics
☐
Vendor Lists
ACKNOWLEDGEMENTS
I, _____________________________, have reviewed the City of Bixby Special Events Guide.
As event organizer, I will ensure all event volunteers and organizers are aware and adhere to the
special event requirements and City of Bixby ordinances. I also understand that by submitting
this application my event is not automatically approved. I understand that I may be asked to
make changes before approval. I also understand that my event may not meet City of Bixby
guidelines and therefore my application may be denied. I certify that the information submitted
in this application is true and to the best of my knowledge correct. I acknowledge that I
understand event fees are non-refundable and refundable deposit fees may be refunded if
guidelines established in the Special Events Guide are met. I also certify that I am authorized to
commit the Host Organization to the aforementioned event and agree to be financially
responsible for any costs and fees that may be incurred by the Event or Organization to the City
of Bixby. I also understand that I must have a copy of the permit awarded at the event and may
be asked to leave if the permit is not available for viewing by a City of Bixby representative.
____________________________________ __________________________
Signature Date
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City of Bixby SPECIAL EVENT PERMIT APPLICATION (City of Bixby)

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Completed 10 June 2021

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